Van Sickle K R, Gallagher A G, Smith C D
Department of Surgery, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7842, San Antonio, TX 78229-3900, USA.
Surg Endosc. 2007 Feb;21(2):220-4. doi: 10.1007/s00464-005-0847-5. Epub 2007 Jan 2.
In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition.
For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded.
Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control).
The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple MIS task and should be given serious consideration in curriculum design for surgical training using simulation tasks.
在获取难以掌握的新技能时，如腹腔镜手术所需技能，反馈是学习过程中的关键组成部分。理想情况下，反馈应准确反映有待改进的任务表现，且应与训练体验密切相关。然而，在外科手术中，反馈通常是在实际操作过程中进行的。虚拟现实训练系统的发展目前提供了新的训练选择。本研究调查了反馈类型和质量对腹腔镜技能获取的影响。
在本研究中，32名腹腔镜新手被前瞻性地随机分为四种训练条件，每组8人。第1组（对照组）没有反馈。第2组（蜂鸣器组）在器械碰到边缘时给予音频反馈。第3组（语音错误组）每次器械碰到腔壁时，有检查人员说出“错误”一词。第4组（两者兼具组）同时接收音频蜂鸣和检查人员说出的“错误”提示。所有受试者使用通过5毫米端口插入的腹腔镜操作笔执行迷宫追踪任务，以模拟微创手术（MIS）中的支点效应。连接到操作笔的计算机在每次碰到迷宫边缘时记录一次错误，并以上述方式让受试者知晓错误。受试者在观看监视器的同时进行十次2分钟的试验。训练结束时，所有受试者完成一项2分钟的简单腹腔镜切割任务试验，记录正确和错误切口的数量。
第4组（两者兼具组）做出的正确切口明显多于其他三组（F = 12.13；自由度 = 3, 28；p < 0.001），并且做出的错误或不正确切口也明显更少（F = 14.4；p < 0.0001）。第4组做出的正确切口数量是第1组（对照组）的三倍，错误切口数量是第1组的七分之一。
在微创手术心理运动技能获取过程中的反馈类型和质量对技能向简单微创手术任务的泛化强度有很大影响，在使用模拟任务进行外科训练的课程设计中应予以认真考虑。
